Asthma Health Equity Index identifies social

ANAHEIM, Calif.—A program at Rady Children’s Hospital-San Diego using an asthma equity dashboard  demonstrates that disparities exist among patients in San Diego with moderate to severe asthma who visit the emergency department, and the index has the potential to help other areas identify and assist such populations.

In “Creating a System to Identify Social Determinants of Health and Achieve Equitable Health Outcomes for Children with Asthma,” researchers at Rady Children’s Health Network developed an Asthma Health Equity Index to redefine how they capture and display equity-related data to address a need for a standardized approach to measure and track health equity-related improvements.

To test the index, the team targeted children living with poorly controlled asthma recently seen in the emergency department and conducted telephone outreach via a patient care coordinator to identify disparities through social determinants of health screenings for food insecurity, housing, transportation, and tobacco use while also ensuring the families had adequate follow-up and asthma education

Race and ethnicity were strongly associated with food insecurity, unstable housing, and tobacco use. Families speaking a language other than English experienced the same challenges, and also experienced transportation challenges. Compared to non-Hispanic White families, patients who identified as Hispanic, non-Hispanic Black and non-Hispanic other were 2 to 4 times more likely to experience unstable housing; Hispanic families were three times more likely to experience food insecurity and transportation issues; non-Hispanic Blacks were two times more likely to experience tobacco use/smoke exposure.

Lastly, when compared to those who speak English, Spanish-speaking patients were 3.3 times more likely to experience food insecurity, and two times more likely to experience unstable housing and transportation issues.

“When managing the health of a child and, in particular, any chronic condition such as asthma, it is critical to acknowledge the profound importance that social determinants, race, ethnicity, and language barriers play in the life of that child and family,” said Dr. Keri L. Carstairs, vice president of network operations and clinical integration and the chief population health officer at Rady Children’s. “By committing to an understanding of those needs that extend beyond the health care setting, we can have a greater impact on the health of children by designing necessary interventions to support these needs through the development of a collaborative community ecosystem with community partnerships that can support vulnerable populations.”

By incorporating social determinants of health screenings into outreach effort and combining this information with demographic data such as race, ethnicity, and zip code details, the authors note, populations and neighborhoods in need of supportive services can more easily be identified and connected with help available in their neighborhoods.

Dr. Keri L. Carstairs is scheduled to present an abstract of the study, available below, during the Section on Minority Health, Equity & Inclusion on Oct. 9, 2022, at 4:45 p.m. PT at the Anaheim Marriott, Marquis Ballroom Center.

To request an interview with Dr. Carstairs or another abstract author, journalists may contact Carlos Delgado at cdelgado@rchsd.org.

Please note: Only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media or may be preparing a longer article for submission to a journal. 

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/

Program Name: 2022 AAP National Conference & Exhibition

Abstract Title: Creating a System to Identify Social Determinants of Health and Achieve Equitable Health Outcomes for Children with Asthma

Keri Carstairs

Rancho Santa Fe, CA, United States

Rady Children’s Health Network (RCHN) was awarded a grant to develop an Asthma Health Equity Index to redefine how we capture and display equity related data to address a need for a standardized approach to measure and track health equity related improvements. RCHSD piloted this index on the severe asthma population recently seen in the Emergency Department (ED) as it is a population disproportionally experiencing more barriers. Many of the children live in neighborhoods with inequities related to poverty, air quality and socioeconomic and cultural factors. Patients are primarily Hispanic (56.1%) and Non-Hispanic Black or Other (23.2%) (Table 1). The index stratifies ED data, demographic data, and Social Determinants of Health (SDOH) to identify gaps and interventions with the shared belief that disparities represent preventable harm, and work to identify systemic processes and structures that promote disparities.

To test the index, we targeted children living with poorly controlled asthma recently seen in the ED to conduct telephonic outreach via a Patient Care Coordinator to identify disparities through SDOH screenings for food insecurity, housing, transportation, and tobacco use. A Population Health Clinical Informaticist compiled SDOH data with demographic data to build a health equity index to identify, track, and prioritize care gaps and develop appropriate interventions for 100% of children seen in the Rady Children’s ED for asthma. The index offers valuable insights detailing location (geo-mapping), race and ethnicity, language, payor type, household income, Prior ED visits, SDOH, and school information. This tool provides real-time information to target specific equity gaps and develop interventions.

Race/Ethnicity was strongly associated with food insecurity (p<.001), unstable housing (p<.001), and tobacco use (p<.001). Language was strongly associated with food insecurity (p<.001), unstable housing (p<.001), and transportation issues (p=.05)When compared to Non-Hispanic (NH) Whites, patients who were Hispanic, NH Black and NH Other were 3-5 times more likely to experience unstable housing (p<.001); Hispanic patients were 3 times more likely to experience food insecurity (<.001) and transportation issues (<.001); NH Blacks were 2 times more likely to experience tobacco use/smoke exposure (<.001) (Table 2). When compared to those who speak English, Spanish-speaking patients were 4.6 times more likely to experience food insecurity (<.001), and 2 times more likely to experience unstable housing (<.001) and transportation issues (.03) (Table 2).

This program and informatics tool allows for the application of a health equity lens to understand social determinants of health, identify interventions, and track outcomes for children living with asthma. In our population, we noted that children living with asthma were at higher risk for SDOH if they were Hispanic and were from Spanish-speaking families. The design is scalable to other conditions and populations to identify high risk populations and aids in community ecosystem development for resource connections.

Rady Children’s Health Network (RCHN) Creating a System to Achieve Equitable Health Outcomes through an Asthma Pilot

Table 2. Social Determinants of Health by Race/Ethnicity and Language

Rady Children’s Health Network (RCHN) Creating a System to Achieve Equitable Health Outcomes through an Asthma Pilot

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